Provider Demographics
NPI:1609629807
Name:BUDDE, MARY LEONA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LEONA
Last Name:BUDDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 E LAKETON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-6223
Mailing Address - Country:US
Mailing Address - Phone:231-773-5433
Mailing Address - Fax:
Practice Address - Street 1:2151 E LAKETON AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-6223
Practice Address - Country:US
Practice Address - Phone:231-773-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker